A summary of my first course in Infant Mental Health

Module 1
Understanding the context of working with Infants and Toddlers

Infant mental health refers to the social, emotional and cognitive well being of infants and young children. Our first 3 years of life experiences are critical to who we are. It makes an impact on development and function throughout our life.
One of the first things Chaya quoted was “....early experiences create a foundation for lifelong learning, behaviour, and both physical and mental health. A strong foundation in the early years increase the probability of positive outcomes and a weak foundation increases the odds of later difficulties.” - The Science of Early Childhood Development, Centre on The Developing Child, Harvard University, 2007. We are our life experiences and this is extremely true of the first three years of life.
There are three theories to consider when it comes to child development. 1. Ecological Theory 2. Transactional Model of Development. 3. Biodevelopmental Framework. To summarize these theories; Ecological Theory is that a child doesn’t develop in isolation. They are influenced by: parents, peers, school and societal norms. His layers show that the closest in relation to him will be the biggest influence; peers second, school third and societal norms last. The Transactional Model of Development is basically the parent’s actions influence the child’s action which, in turn influence the parent’s actions. The Biodevelopmental Framework takes science to help us understand that early experiences get into the body.
Often we are faced with trying to explain in sensitive, politically correct laymen’s terms how healthy child development happens, how it doesn’t happen and what we can do to keep things going well! It’s my job as an Early Interventionist to explain to parents how early experiences are biologically embedded in the development of the brain and other organ systems which sometimes is a hard sell. As well as how it has long-term impacts on physical and mental health and cognitive, language, and social skills. Positive early experiences lay a foundation for healthy development, but adverse experiences can weaken that foundation. Often parents have experienced adverse experience themselves in their first years of life and take the “well I turned out ok” stand. They feel as if safeguards to insure positive early experiences is unnecessary. We need user friendly information for these parents that will teach them a wide range of positive parenting skills such as: to safeguard from injury, nutrition-affordable healthy age-appropriate meal planning and to make sure there is safe places to play within the home and community. Our early experiences actually chemically mould us. Biologically our environment of relationships, physical, chemical, and built environments, and early nutrition can influence a lifetime of well-being or a life time of being unwell. The biggest factors that undermine the development of infant and toddlers brains are prenatal alcohol and substance abuse & postnatal recurring experiences such as abuse, chronic neglect, or exposure to violence & family economic hardship. Not only do we have to try to explain this to parents but we have to make sure we also protect the infants and toddlers that are in high risk situations. Bottom line early experiences affect adult outcomes in educational achievement and economic productivity as well as mental and physical health later in life. The truth is children who live in healthy positive environments tend to go on to complete school, have higher paying jobs, live healthier lifestyles and live longer. On the other hand those children who live in adverse environments may have impaired learning, maladaptive behaviour, chronic illness, disability and a shorter lifespan. We know more now than ever before about how young children learn and develop and how to promote competencies in a variety of domains. It’s our responsibility to teach this to parents we work with.


Module 2
Developmental Outcomes and Child-Parent Attachment

I loved the quote form Heckman that basically early success breeds later success and early failure breeds later failure! While it is a very simplistic statement it rings very true! We need to teach this simplistic truth to parents and caregivers.

Development is both influenced by a child’s environment and genetics. I feel like the nature and nurture concept comes into play here. The genetics factor and temperament a child is born with play a huge role in whom that child is. Also how their caregivers’ respond to their temperament and the quality and consistency of interaction within this child’s environment will mould and make them who they are. Both the parents and child’s temperament will affect attachment in either a negative or positive way.

With my job as an Early Interventionist we regularly use Ages & Stages Questionnaires for assessing our clients every 6 months. I am familiar with the invest in kids website and think it’s a wonderful tool. I love using the Ages & Stages Questionnaires with my clients. It is a quick and easy way to see where a child is developmentally and it’s also easy for the caregivers to understand.
Working with parents to understand temperament of their child is an important role for us. Temperament is a trait we are all born with and will have throughout our life. Temperament is both genetics and environment but genetics is a very strong component. It influences a child’s ability to cope with day to day life.
“Attachment – children become attached to their parent/caregiver when they respond to the child’s distress, bottom line! If we protect from harm, respond to needs, especially when distressed we will have infants with secure attachment. The attachment relationship reflects the baby’s efforts to seek comfort, support, nurturance, and protection from a small number of adult caregivers.” (Zeanah, 2009)
There are 4 types of Attachment
Secure- Infants show a balance of attention to Mom and toys. They explore freely when Mom is present, when separated reactions vary but upon return they are consistently positive toward their Mom. Mom is very quick to respond to baby when distressed with comfort.
Avoidant-Infants appear to be quite independent and very busy with the toys in Mom’s presences and show little distress at her departure, and may snub or ignore her upon her return. Mom is typically unresponsive to distress and seems uncomfortable with close body contact.
Ambivalent/Resistant-Infant appears preoccupied with Mom; they explore very little when Mom is present, become distressed when Mom leaves. Will seek comfort when reunited but will not settle and may even resist Mom’s comfort. Mom is typically inconsistent in response to baby’s distress.
Disorganized-Infant has mixed strategies that use a combination of secure, avoidant and resistant attachment. This is most predictive of later psychopathology. (Zeanah, 2009)
Often in my job I find different levels of attachment between caregivers and their children. Through observation I can generally figure out what type of attachment children have. Then work from their in teaching caregivers how to meet their infants/toddlers needs and form positive attachment when possible.

Module 3
Observation, Screening & Assessment

Indentifying delays and implementing interventions within the first two years is critical the longer we wait the less likely we will be able to change the course or direction the child’s development is going in.
Observing, screening and assessing children are the majority of what I do as an Early Interventionist. I have the privilege to go into these children’s homes and observe, screen and assess them in their own environment. It helps me to not only know where the child is developmentally but it also helps to form a relationship with both the child and the parent(s) I’m working with.
Observation provides useful information about how children and families behave, interact and relate to each other. When I go to a family I work with I bring a home summary sheet. On that sheet I generally talk about what things we did and worked on that day. I also put observations of both the caregiver and the child. Often they are positive improvement observations but there are also times when I observe things that need to be improved or addressed and I will add that to the summary as well. The parents have to read and sign this summary and they receive the carbon copy and I the original. Often these observations help the caregivers to keep fighting the good fight and as well motivate other caregivers to try harder with their children.
Screening is the first step in identifying red flags. As of this date in NB the Early Interventionist has not starting the screening process. It is something we will be doing eventually from what I gather. However the screening process as to whom we will have as clients comes from both Public Health and Social Development at present.
Assessments are a detailed evaluation of a child. Right now with my job we use ASQ:3 and the ASQ:SE. (Look up Ages and Stages online). The ASQ helps to identify delays as early as possible, save time and money, makes my job easier and is very parent friendly. It also has fun, fast and inexpensive activities for sharing with parents. These activities are geared to help the child in the areas that he is behind developmentally in a fun, interactive way. The ASQ is also standardized and can be used in court if and when necessary.
The information collected from observations, screening and assessments can be used to: establish relationships with families, refer children on to experts that are needed, identify resources that can help with the child’s development & provide age appropriate stimuli and activities designed to enhance development.
When working with families we also need to take into consideration cultural differences. Some of these include: 1. Language Barrier is said to be the number one obstacle when a family comes to Canada. This could affect how a parent may answer a question. Assessments in other languages and translators would be a good resource in this area. 2. Religion & Oral VS written Culture. Often families who come to our country have different beliefs in child rearing and we need to learn to work within their culture and seek guidance from others within our agency or department that could help us in that area. 3. Interdependent VS Independent Culture. Many newcomer families have a big emphasis on social support and the extended families. Teaching children at a young age to be independent isn’t as important as teaching them social skills. Many screening tools ask questions regarding independence which isn’t a high priority for them. 4. Adult-Child Interaction. Culturally a family could interact differently than Canadian families. Also the lack of adult – child interaction could be attributed to the stress of moving to a new country.
When working with these families we need to be ever mindful of the challenges these factors bring.


Module 4
Risks and Protective Factors

When we look at risk factors to a child’s development we look at both biological and environmental factors. There are several different areas of risk including: The parent (lack of parenting skills, delayed, mental illness, chronic health issues, etc.), The parent-child interaction (insensitive or rejecting child, harsh discipline, frightening behaviour toward child etc.), Home/Family Environment (dysfunction, addiction, partner violence, lack of food, housing etc.), Community (violence, poverty, inadequate housing etc.) and Society (inadequate health and social recourses, lack of employment opportunities etc.). So when trying to reduce or eliminate these risk factors for families some of thing I may look for is low income housing, food banks, free parenting courses, parent and child services , addiction counselling, employment opportunities etc.
When looking at protective factors we look at attributes and or conditions that improve resilience in a child when faced with less than ideal circumstances.
Resilience is the ability to recover. When babies experience neglect all the time, they do not have the ability to become resilient thus hindering their emotional well-being.
The “The Still-Face Experiment” video by Dr Edward Tronick was very enlightening. We saw in the video a child with good attachment to their Mom quickly become agitated when she could figure out how to make Mom respond to her. Who also quickly show resilience when Mom started responding again. She was able to recover from the very few moments of neglect she experienced. This video touched me inside. It made me think of the many children who are neglected all the time and are left emotionally unwell. (The 2 min video can be found on You Tube look up “The Still-Face Experiment).
With my work as an Early Interventionist I go to other homes where the child’s environment includes a strong Mom-child attachment, nurturance, responsiveness, and love.
I’ve also seen Mom’s not responding to their infant’s needs. I tend to remind them that babies can’t be spoiled and that to form a good attachment they need to meet their child’s needs. Sometimes it’s met with “oh he knows how to push my buttons” or “oh yes he is spoiled.” That is when I generally bring out the DVD “A Simple Gift” Comforting your baby to the next visit.
Overall, this course has taught me the importance of Infant Mental Health and teaching caregivers the importance as well. Teaching caregivers Infant Mental health refers to an infant’s ability to experience emotions, develop relationships and learn. They learn about themselves and the world around them through the relationships they have with the people in their lives. Infants who are made to feel loved and cherished learn that they are lovable and are able to love. Mentally and emotionally healthy babies usually make for mentally and emotionally healthy adults.